Vertical bone augmentation of posterior mandibular region: a description of two surgical techniques

ABSTRACT Correction of severe vertical bone deficiency in the posterior region of mandibular alveolar ridge requires surgical management if implants are scheduled and cannot have primary stability. The aim of the present study is to report two cases; one treated with alveolar osteogenesis distraction and the other with segmental osteotomy with autologous graft interposition, by describing the surgical steps as well as show the results and experiences acquired with these techniques. We opted for these methods to reconstruct the posterior mandibular region after remarkable vertical bone loss based mainly by the height and thickness of the remaining bone. Alveolar osteogenic distraction is highly advisable when vertical deficiency is severe, and if these cases are treated with the segmental osteotomy and autologous graft interposition, complications as graft failure, necrosis and resorption are more prone to occur due to insufficient vascularization. After bone maturation and bone neoformation secondary to alveolar osteogenic osteogenic distraction and segmental osteotomy with autologous graft interposition, respectively, the two presented case reports were able to securely receive dental implants. In cases of vertical bone loss of the posterior mandibular region, both surgeries currently represent the best choice for bone gain prior dental implants placement for oral rehabilitation, without technical challenges, although biological evidence to assure the superiority of one technique over the other must be further investigated.

摘要：若下颌牙槽嵴后部存在重度垂直骨量不足，且计划植入牙种植体（dental implant）却无法获得初始稳定性，则需采取外科手术干预。本研究旨在报告两例临床病例：一例采用牙槽骨牵张成骨（alveolar osteogenesis distraction）治疗，另一例采用节段性截骨联合自体植骨植入术（segmental osteotomy with autologous graft interposition）治疗；文中将详细描述手术操作步骤，并展示两种技术的应用效果与临床实践经验。我们根据患者剩余骨组织的高度与厚度，针对下颌后部出现显著垂直骨丢失的病例，选择上述两种方案实施骨缺损重建。当垂直骨量不足程度较为严重时，牙槽骨牵张成骨是推荐度较高的治疗选择；而若采用节段性截骨联合自体植骨植入术治疗此类病例，则因术区血管供给不足，更易出现植骨失败、骨坏死及骨吸收等并发症。分别经牙槽骨牵张成骨术后的骨成熟与骨新生、节段性截骨联合自体植骨植入术后，两例病例均可成功植入牙种植体。当下颌后部出现垂直骨量丢失时，上述两种手术方案目前均为口腔功能重建术前获取足够骨量的最优选择，操作并无过高技术难度，但仍需开展进一步研究以获取生物学证据，证实其中一种技术的临床优越性优于另一种。